A Pharmacist's Guide to OTC Therapy: Children's Pain Relievers

Monica Holmberg, PharmD

Published Online: Wednesday, March 1, 2006

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Choosing an OTC pain reliever can be a challenging task for a parent. A myriad of products exist?drops, suspensions, tablets, and chewable tablets. Complicating the situation further, the products are marketed to a range of patient populations: infants, children, and juniors. Finally, the parent of a child in pain is likely to be concerned, preoccupied, and in a hurry to help the hurt go away. The pharmacist's intervention can help simplify product selection and ensure that the child will receive pain relief that is both safe and effective.

The 2 primary pediatric OTC pain relievers available in the United States are acetaminophen and ibuprofen. Because of its association with Reye's syndrome, treatment with aspirin should be avoided in children and teenagers with chickenpox or flu-like symptoms.1

Acetaminophen

Acetaminophen requires a physician's consent for patients who are <2 years old. Acetaminophen doses should be weight-based. Many health care professionals recommend oral acetaminophen doses of 10 to 15 mg/kg every 4 to 6 hours, with a maximum of 5 doses per day. Basing doses on the child's weight in pounds, however, often is easier for parents (Table 1).2,3

Patient counseling is a critical step in acetaminophen therapy. The drug's availability in multiple strengths (100- mg/mL drops, 32-mg/mL suspension, 80-mg tablets, and 160-mg tablets) greatly increases the potential for medication overdoses. The pharmacist should be sure that parents understand which formulation they have and how much to use. They should have a dropper and a dosing cup available, both for teaching purposes and for use at home. Acetaminophen should not be used for longer than 5 consecutive days.4

Ibuprofen

Ibuprofen can be used in patients >6 months old. When used for analgesia, some health care professionals recommend doses of 4 to 10 mg/kg every 6 to 8 hours, with a maximum of 4 doses per day. As with acetaminophen, basing doses on the child's weight in pounds may be more useful for parents (Tables 2 and 3).2,5,6

Ibuprofen should be avoided in patients with a history of hypersensitivity to the drug. Caution is needed with patients using other medications such as blood thinners or diuretics. Parents should be advised to give ibuprofen with food or milk and to discontinue its use if stomach upset occurs or worsens. Ibuprofen should not be used for longer than 3 consecutive days.5,6

Both acetaminophen and ibuprofen are marketed in a variety of flavors and preparations to help even the most finicky patient get the medicine down (Tables 4 and 5).